This reason code should be used if per our individual Clients’ policies the Service, Benefit, or Supply billed is not covered.

This reason code should be used by the Non-Clinical Investigator. It is used when a specific analytic is hit regarding a claim that is in danger of being paid at a higher amount.

This reason code should be used if the billed procedure code is a time based code and does not meet the code requirements outlined in the CPT code description.

This reason code should be used if the case/claim line will not receive a Clinical Review.

This reason code should be used if the documentation does not support the laboratory code billed.

This reason code should be used if the medical records submitted are incorrect.

This reason code should be used if the billed procedure code is unbundled from the other procedure codes billed.

This reason code should be used if documentation was not received from the Provider.

This reason code should be used if no medical records were received for the date of service billed or if pieces of medical records are missing.

This reason code should be used if the medical records do not support the amount of Units billed.

This reason code should be used if the medical records support a different modifier than what was billed.

This reason code should be used if the billed E/M (Evaluation and Management code) is unbundled from the other procedure codes billed.

This reason code should be used if the billing provider is ineligible to bill a certain code.

This reason code should be used if all of the documentation is supported and no errors are noted in the clinical review

This reason code should be used if the medical records do not match the date of service billed.

This reason code should be used if the billed E/M (Evaluation and Management code) does not meet the code requirements outlined in the CPT code description.

This reason code should be used if the medical records do not support the billed codes.

This reason code should be used if an add-on code was billed and the appropriate primary procedure code was not supported.

This reason code should be used if the billed procedure code does not meet the code requirements outlined in the CPT code description.

This reason code should be used if an add-on code was billed but the appropriate primary procedure code was not.

This reason code should be used if the case needs to be stopped/closed pending further direction from Client and/or Leadership.